25 tools that improve the restorative workflow

From analog to digital, here are the things that can make restorative dentistry better than ever.

Creating the best dental work—be it crowns, bridges, implants or even dentures—requires a certain level of mastery from both the dentist and his or her laboratory. In some cases, those restorations can be achieved while the patient is in the chair. In other cases, the restoration must be sent to the laboratory. In either case, clinicians and labs rely on any number of tools—and on each other—to help get the job done.

Those tools can be anything from a simple, inexpensive carving knife up to a complete chairside milling system costing thousands (if not hundreds of thousands) of dollars.

For many dental professionals, the full arsenal of restorative tools remains a mystery beyond what they’re using day to day. But that segmented way of working doesn’t have to be the norm—dental technicians can benefit from knowing what’s going on chairside, and dentists must know what’s going on in the lab. That kind of full-workflow knowledge creates better results from start to finish, helps position dental laboratories as expert consultants, provides clinicians with the knowledge to ensure better patient outcomes and gives the folks in the dental chair the assurance their restorations are perfect every time.

Whether you’re a dentist, a dental technician or another specialist, knowing what equipment is most important can make all the difference. With that in mind, we talked with several doctors, lab professionals and dental technology experts to find out what they thought is essential gear for the restorative process in 2017.

Doctors and laboratories utilize specific hand tools to make their restorations look and fit just right. Some are very basic tools that have been around for decades (and may not even be popularly used anymore) and others are purpose-built for new technologies.

Facebow and articulator

“I don’t know if you’d call it technology because it’s been around so long,” Dr. David Rice, DDS, a general dentist in Amherst, New York, and founder of IgniteDDS.com, says. “But a facebow and an articulator go hand-in-hand. The facebow is the clinical piece that I use for the patient’s mouth, and the articulator is more on the laboratory side. What that allows for is a true representation of the patient’s mouth in the model phase, so the laboratory can not only know how the teeth come together, but they can predict how a jaw would move and at what angle.”

Dr. Rice observes that the tool might not be something many dentists have ever used. “It’s, sadly, sort of a lost piece of tried-and-true technology,” he says. “It’s something many dentists have shied away from using. Probably because they never learned how to in dental school or they have just gotten away from it, but it makes life so much easier when you use it.”

Carving tools

Dan Elfring, an in-house lab tech at Pickle Prosthodontics in Colorado Springs, Colorado, uses a variety of carving tools for sculpting wax. For instance, he has a tool used specifically for defining details in dentures.

“It’s used for carving around the gingival crest of a denture,” Elfring says. “So you wax it up and then you use it to carve that nice line around the gingival crest.”

Another tool he uses is a Lecron carver, used in denture base creation.

“When I’m waxing up a denture base, mostly I’m carving in wax,” Elfring says. “And it’s after I do a bulk wax and I carve it back.”

A leaf gauge is an inexpensive diagnostic tool—comprised of several thin leaves—and is used for measuring the bite.

“If you get really technical with teeth, the position of teeth is really determined by a few things,” Dr. Rice says. “It’s how they look, like when somebody smiles, but it’s also determined by the muscles, the musculature of the jaw, and something really simple, like a leaf gauge, helps me to make sure I’m building my bite with my teeth in harmony with the muscles and then the temporomandibular joint.”

Acrylic mixer

Some tools may seem simple, but they serve an important purpose. For instance, Elfring uses an acrylic mixer to ensure that the resulting product is smooth and bubble-free.

“It’s got a spoon on one end to spoon the polymer out of a bottle, and that’s got a little mixing spatula on the other end,” he describes. “So what’s kind of unique is that it’s kind of open so that it doesn’t create too much turbulence when you’re mixing.”

Clamps

Laboratories rely on clamps when fabricating restorations, and they can be used for very specific, specialized functions. For example, Mark Ferguson, general manager of Vulcan Custom Dental, notes that a clamp from Harvest Dental called Clip makes the manufacture of implant cases much easier.

“It’s a tool that is used to clamp hybrid implant bases to their ceramic counterpart,” Ferguson says. “Whether it be zirconia or e.max, it makes cementation of hybrid implant cases quite a bit easier.”

Getting restorations to a smooth finish can be achieved by using rotary tools with progressively finer grits.

“With the trend of everybody going all-ceramic, with zirconia and e.max and lithium disilicate, the all-ceramic trend is changing the way we finish things,” Jason Atwood, CDT, Senior Digital Solutions Adviser of Core3dcentres, says. “Carbides are a thing of the past. Almost everybody is using diamonds and stones and rubber wheels to do their finishing and fitting. I recommend, when finishing your margins and things like that, on an all-ceramic crown to use a good, diamond-impregnated rubber wheel.”

For example, Ferguson notes that Wagner offers its “Berrys” line GoldenBerry, RedBerry and BlueBerry.

“They’re fantastic for polishing and working with zirconia and lithium disilicate,” he says.